Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction.

Methods

We conducted a meta-analysisat the individual-patient level using data from five open-label trials that randomly assigned patients with recent myocardial infarction, no other indications for beta-blocker therapy, and an LVEF of at least 50% to receive beta-blocker therapy or no beta-blocker therapy.

我们使用来自五项开放标签试验的个体患者数据进行了一项荟萃分析，这些试验随机分配了近期心肌梗死、没有其他β受体阻滞剂治疗指征且LVEF至少为50%的患者，接受β受体阻滞剂治疗或不接受β受体阻滞剂治疗。

The primary end point was a composite of death from any cause, myocardial infarction, or heart failure.

主要终点是任何原因导致的死亡、心肌梗死或心力衰竭的复合终点。

Event rates were analyzed with a one-stage fixed-effects Cox proportional-hazards model.

事件率采用一阶段固定效应Cox比例风险模型进行分析。

Results

A total of 17,801 patients were included from the REBOOT (7459 patients), REDUCE-AMI (4967 patients), BETAMI (2441 patients), DANBLOCK (2277 patients), and CAPITAL-RCT (657 patients) trials.

共有17,801名患者纳入REBOOT（7459名患者）、REDUCE-AMI（4967名患者）、BETAMI（2441名患者）、DANBLOCK（2277名患者）和CAPITAL-RCT（657名患者）试验。

Of these 17,801 patients, 8831 (49.6%) were assigned to receive a beta-blocker and 8970 (50.4%) were assigned to receive no beta-blocker.

在这17,801名患者中，8831名（49.6%）被分配接受β受体阻滞剂治疗，而8970名（50.4%）被分配不接受β受体阻滞剂治疗。

During a median follow-up of 3.6 years (interquartile range, 2.3 to 4.6), a primary-end-point event occurred in 717 patients (8.1%) in the beta-blocker group and 748 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.97; 95% confidence interval[CI], 0.87 to 1.07; P = 0.54).

在中位随访时间为3.6年（四分位数范围，2.3至4.6年）期间，β受体阻滞剂组有717名患者（8.1%）和无β受体阻滞剂组有748名患者（8.3%）发生了主要终点事件（风险比，0.97；95%置信区间[CI]，0.87至1.07；P = 0.54）。

Death from any cause occurred in 335 patients in the beta-blocker group and 326 patients in the no-beta-blocker group (hazard ratio, 1.04; 95% CI, 0.89 to 1.21); myocardial infarction occurred in 360 and 407 patients, respectively (hazard ratio, 0.89; 95% CI, 0.77 to 1.03); and heart failure occurred in 75 and 87 patients (hazard ratio, 0.87; 95% CI, 0.64 to 1.19).

在β受体阻滞剂组中，有335名患者因任何原因死亡，在无β受体阻滞剂组中，有326名患者死亡（风险比，1.04；95%置信区间[CI]，0.89至1.21）；心肌梗死分别发生在360名和407名患者中（风险比，0.89；95%置信区间[CI]，0.77至1.03）；心力衰竭分别发生在75名和87名患者中（风险比，0.87；95%置信区间[CI]，0.64至1.19）。

Conclusions

In this meta-analysisincluding individual-patient data from five randomized trials, beta-blocker therapy did not reduce the incidenceof death from any cause, myocardial infarction, or heart failure in patients with an LVEF of at least 50% after myocardial infarction without other indications for beta-blockers.

在这项纳入五项随机试验的个体患者数据的荟萃分析中，对于心肌梗死后左心室射血分数至少为50%且没有其他使用β受体阻滞剂指征的患者，β受体阻滞剂治疗并未降低任何原因导致的死亡、心肌梗死或心力衰竭的发生率。

(Funded by Centro Nacional de Investigaciones Cardiovasculares Carlos III and others; PROSPERO database number, CRD420251119176.).

(该研究由Centro Nacional de Investigaciones Cardiovasculares Carlos III和其他机构资助；PROSPERO数据库编号，CRD420251119176。)